Image-guided Ommaya reservoir insertion for intraventricular chemotherapy: a retrospective series
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Ayub Ommaya proposed a surgical technique for subcutaneous reservoir and pump placement in 1963 to allow access to intraventricular cerebrospinal fluid (CSF). Currently, the most common indication for Ommaya reservoir insertion (ORI) in adults is for patients with hematologic or leptomeningeal disorders requiring repeated injection of chemotherapy into the CSF space. Historically, the intraventricular catheter has been inserted blindly based on anatomical landmarks. The purpose of this study was to examine short-term complication rates with ORI with image guidance (IG) and without image guidance (non-IG).
We retrospectively evaluated all operative cases of ORI from 2000 to 2014 by the senior author. Patient demographic data, surgical outcomes, and peri-operative complications were collected. Accurate placement and early (30-day) morbidity or mortality were considered primary outcomes.
Fifty-five consecutive patients underwent ORI by the senior author over the study period (43.5 ± 16.6 years; 40.0% female). Indications for placement included acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and leptomeningeal carcinomatosis. There were seven (12.7%) total complications: three (37.5%) with no-IG versus four (8.5%) with IG. Catheter malpositions were significantly higher in the non-IG group at 37.5% compared to 2.1%. Catheters were also more likely to require multiple passes with non-IG at 25% compare to 0% with IG. There were no early infections in either group.
We demonstrate improved accuracy and decreased complications using an image-guided approach compared with a traditional approach. Our results support routine use of intra-operative image guidance for proximal catheter insertion in elective ORI for intraventricular chemotherapy.
KeywordsNeuronavigation Ommaya reservoir Neurosurgery Neuro-oncology–surgical Imaging
Acute lymphoblastic leukemia
American Society of Anesthesiologists
Chronic myelogenous leukemia
London Health Sciences Centre
Magnetic resonance imaging
Ommaya reservoir insertion
Spoiled gradient recalled (MRI sequence)
J. C. L is funded through the Western University Clinical Investigator Program accredited by the Royal College of Physicians and Surgeons of Canada and a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Doctoral Award Scholarship. S. K. is funded through the Western University Schulich Medicine and Dentistry Medical Student Research Training Program (SRTP). The sponsors had no role in the design or conduct of this research.
Compliance with ethical standards
Conflict of interest
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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